A systematic review and meta-analysis of x-ray therapy versus proton beam therapy for pediatric central nervous system germ cell tumors: TRP-Germinoma 2025

Introduction Central nervous system germ cell tumors (CNS-GCTs) are rare pediatric tumors, categorized into germinomas and non-germinomatous germ cell tumors (NGGCTs). Proton-beam therapy (PBT) has been introduced as an alternative to X-ray therapy (XRT) for minimizing radiation exposure to normal brain tissue, but evidence comparing these treatment modalities is limited. Methods A systematic review and meta-analysis following PRISMA guidelines was conducted using PubMed for studies published between 1990 and 2022. Studies reporting overall survival (OS) and progression-free survival (PFS) for CNS-GCTs treated with PBT or XRT were included. Random-effects meta-analyses compared 3- and 5-year OS and PFS between treatment modalities. Results Forty-one studies were selected, with 36 on XRT and five on PBT. In germinoma patients, no significant differences were found between XRT and PBT for 3-year OS (95.3% vs 97.8%, p = 0.3158), 5-year OS (94.8% vs 97.8%, p = 0.3088), 3-year PFS (90.7% vs 97.1%, p = 0.1045), or 5-year PFS (89.2% vs 91.7%, p = 0.4676). The collected data were insufficient to evaluate PBT in NGGCTs. Conclusion PBT and XRT showed comparable survival outcomes in germinoma. Further research is required to explore PBT’s potential benefits in preserving cognitive function or reducing secondary cancers.